Ivlev Ilya, Hickman Erin N, McDonagh Marian S, Eden Karen B
Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.
Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.
J Gen Intern Med. 2017 Jul;32(7):803-812. doi: 10.1007/s11606-017-4027-9. Epub 2017 Mar 13.
As breast cancer screening guidelines have changed recently, additional investigation is needed to understand changes in women's behavior after using breast cancer screening patient decision aids (BCS-PtDAs) and the potential effect on mammography utilization. This systematic review and meta-analysis sought to evaluate the effect of BCS-PtDAs on changes in women's intentions to undergo screening mammography and whether women deciding to begin or discontinue screening mammography displayed similar changes in screening intentions after using a BCS-PtDA.
We searched Medline, Scopus, PsycINFO, CENTRAL, Health and Psychosocial Instruments, Health Technology Assessment Database, PsycARTICLES, and cited references in eligible papers for randomized controlled trials (RCTs) and observational studies, published through August 24, 2016. The proportions of women who did and not intend to undergo screening and who were uncertain about undergoing screening mammography were pooled, using risk ratios (RR) and random effects. According to the protocol, RCTs or observational studies and any language were considered eligible for systematic review if they included data about women for which shared decision making is recommended.
We ultimately included six studies with screening intention data for 2040 women. Compared to usual care, the use of BCS-PtDAs in three RCTs resulted in significantly more women deciding not to undergo screening mammography (RR 1.48 [95% CI 1.04-2.13]; P = 0.03), particularly for younger (38-50 years) women (1.77 [1.34-2.34]; P < 0.001). The use of BCS-PtDAs had a non-significant effect on the intentions of older women (69-89 years) to discontinue screening.
The use of BCS-PtDAs increased younger women's reluctance to undergo screening for breast cancer. The implementation of such BCS-PtDAs in clinical practice would be expected to result in a 77% increase in the number of younger women (aged 38-50) who do not intend to be screened, and as a consequence, may reduce utilization of screening mammography.
The protocol of this review is registered in the PROSPERO database, #CRD42016036695.
由于乳腺癌筛查指南最近发生了变化，需要进行更多调查，以了解女性在使用乳腺癌筛查患者决策辅助工具（BCS-PtDAs）后的行为变化以及对乳房X线摄影利用率的潜在影响。这项系统评价和荟萃分析旨在评估BCS-PtDAs对女性接受乳房X线筛查意愿变化的影响，以及决定开始或停止乳房X线筛查的女性在使用BCS-PtDA后筛查意愿是否有类似变化。
我们检索了Medline、Scopus、PsycINFO、CENTRAL、健康与心理社会测量工具、卫生技术评估数据库、PsycARTICLES以及符合条件论文中的参考文献，以查找截至2016年8月24日发表的随机对照试验（RCT）和观察性研究。使用风险比（RR）和随机效应，汇总了打算和不打算接受筛查以及对接受乳房X线筛查不确定的女性比例。根据方案，如果RCT或观察性研究包含有关建议共同决策的女性的数据，则无论语言如何，均被视为符合系统评价的条件。
我们最终纳入了六项研究，这些研究提供了2040名女性的筛查意愿数据。与常规护理相比，三项RCT中使用BCS-PtDAs导致更多女性决定不接受乳房X线筛查（RR 1.48 [95% CI 1.04 - 2.13]；P = 0.03），特别是对于年龄较小（38 - 50岁）的女性（1.77 [1.34 - 2.34]；P < 0.001）。使用BCS-PtDAs对老年女性（69 - 89岁）停止筛查的意愿没有显著影响。
使用BCS-PtDAs增加了年轻女性对乳腺癌筛查的抵触情绪。在临床实践中实施此类BCS-PtDAs预计将导致不打算接受筛查的年轻女性（38 - 50岁）数量增加77%，因此可能会降低乳房X线筛查的利用率。
本评价方案已在PROSPERO数据库中注册，#CRD42016036695。
